Advancing patient safety governance in the COVID-19 response

In the backdrop of the COVID-19 pandemic, ensuring the safety of health care services remains a serious, ongoing challenge. This once-in-a-century global health crisis exposed the vulnerability of healthcare delivery systems and the subsequent risks of patient harm. Given the scale of the occurrence and costs of preventable patient safety events, intervention and investment are still relatively modest. Good patient safety governance focuses on what leaders and policy makers can do to improve system performance and reduce the financial burden of avoidable care. Moreover, it is essential in driving progress in improving safety outcomes. This report examines how patient safety governance mechanisms in OECD countries have withstood the test of COVID-19 and provides recommendations for countries in further improving patient safety governance and strengthening health system resilience.

The economics of patient safety: from analysis to action

Over 1 in 10 patients continue to be harmed from safety lapses during their care. Globally, unsafe care results in well over 3 million deaths each year. The health burden of harm is estimated at 64 million Disability-Adjusted Life Years (DALYs) a year, similar to that of HIV/AIDS. Most of this burden is felt in low- to middle-income countries (LMICs). Recent estimates suggest that as many as 4 in 100 people die from unsafe care in the developing world. The SARS-cov-2 pandemic has highlighted the risk of patient harm, with the estimated proportion of healthcare-acquired infections ranging from 12.5% to 65%. Evidence suggests that the incidence of other harms has increased during the pandemic as health system capacity has become challenged. Unsafe care also has high financial and economic costs. In developed countries, the direct cost of treating patients who have been harmed during their care approaches 13% of health spending. Excluding safety lapses that may not be preventable puts this figure at 8.7% of health expenditure. This amounts to USD 606 Billion a year, just over 1% of OECD countries' combined economic output. The indirect economic and social burden of unsafe care is even greater, exerting a far from negligible brake on productivity and growth. Based on willingness to pay, the social cost can be valued at USD 1 to 2 trillion a year. A human capital approach suggests that eliminating patient harm could boost global economic growth by over 0.7% a year. This seemingly small number would have compounded to approximately USD 118 trillion between 2000 and 2020. Governments, health systems and care providers have a duty to protect patients and the public from harm. Moving from analysis to action requires sober and rational decisions on how safety strategies, programmes and interventions can be implemented in a context of limited resources to generate the best value and return on investment (ROI) across a system. Improving safety requires a whole of system approach, with the value created by implementing and investing in mutually re-enforcing interventions within a policy framework encompassing all health system strata (Figure 1.1). The importance co-ordinating efforts has been recently highlighted by the responses to the covid-19 pandemic where, in many countries, agencies within and outside health systems have harmonised efforts quickly and effectively to manage risk and minimise harm from the outbreak.

International comparisons of the quality and outcomes of integrated care: findings of the OECD pilot on stroke and chronic heart failure

Across OECD countries, aging populations and increasing numbers of people with chronic diseases shift the focus of health care delivery beyond acute hospital care. Almost two in three people aged over 65 years live with at least one chronic condition often requiring multiple interactions with different providers, making them more susceptible to poor and fragmented care. This has prompted calls for making health systems more people-centred, and has fuelled debate on the need for integrated delivery systems capable of continuous, co-ordinated, and high-quality care delivery throughout people's lifetime. Despite promising, mostly local-level, experiences of integrated care models, health care systems remain fragmented, focused on episodic acute care and unsuitable to solve complex health needs. Moreover, assessing and quantifying the benefits of integrated care in a comparable way remains difficult due to the lack of technically sound, policy-relevant indicators of care integration. The COVID-19 pandemic has amplified the need for various parts of the health systems to work together to deliver seamless care. New models of care delivery are relocating acute care outside the hospital, broadening coverage of primary health care, accentuating home based care and blurring the boundaries between health and social care, whilst increasingly relying on digital solutions. This report presents the results of the first OECD pilot over the period 2020-2021 that developed quality and outcome indicators to support cross-country comparisons of the delivery of integrated care. A new generation of indicators was published in Health at a Glance 2021 to launch international benchmarking of quality measurement of integrated care. The results and experience with the pilot call for further work on four fronts: (1) expanding work on indicator development;(2) performing policy analysis to better understand cross-country variations and influencing factors such as health financing and governance models;(3) encouraging more countries to upscale data linkage and measure delivery of integrated care;and (4) developing new measures of the level of integration of OECD health systems.

Health data and governance developments in relation to COVID-19: how OECD countries are adjusting health data systems for the new normal

At the onset of the COVID-19 pandemic many countries found that they lacked basic, timely data for decision making - such as information on health workforce, resources, hospitalisations, and mortality. Many policy makers have since leveraged COVID-19 related information system reforms in a way that may also address long-standing barriers in the structures, policies and institutions that have kept countries from fully utilising health related data. Health data governance reforms, in particular, have been an important aspect of countries responses. Improvements in the quality, coverage, completeness, and capacity for data sharing in regard to existing national personal health datasets were widely reported. Countries have also made significant investments in digital tools, systems for public health monitoring, assessments of resource use and availability, and data to monitor the status of non-COVID related health needs.

Developing international benchmarks of patient safety culture in hospital care: findings of the OECD patient safety culture pilot data collection and considerations for future work

Improving patient safety culture (PSC) is a significant priority for OECD countries as they work to improve healthcare quality and safety-a goal that has increased in importance as countries have faced new safety concerns connected to the COVID-19 pandemic. Findings from benchmarking work in PSC show that there is significant room for improvement. Across included survey findings from OECD countries, less than half (46%) of surveyed health workers believe that important patient care information is transferred across hospital units and during shift changes. Just two-in-five surveyed health workers in OECD countries believe the staffing levels at their workplace are appropriate for ensuring patient safety (40%) or that mistakes and event reports would not held against them (41%). International benchmarking is a feasible and useful addition to exiting measurement initiatives on safety culture and may help accelerate necessary improvements in patient safety outcomes.

Managing COVID-19 within and across health systems: why we need performance intelligence to coordinate a global response.

BACKGROUND: The COVID-19 pandemic is a complex global public health crisis presenting clinical, organisational and system-wide challenges. Different research perspectives on health are needed in order to manage and monitor this crisis. Performance intelligence is an approach that emphasises the need for different research perspectives in supporting health systems' decision-makers to determine policies based on well-informed choices. In this paper, we present the viewpoint of the Innovative Training Network for Healthcare Performance Intelligence Professionals (HealthPros) on how performance intelligence can be used during and after the COVID-19 pandemic. DISCUSSION: A lack of standardised information, paired with limited discussion and alignment between countries contribute to uncertainty in decision-making in all countries. Consequently, a plethora of different non-data-driven and uncoordinated approaches to address the outbreak are noted worldwide. Comparative health system research is needed to help countries shape their response models in social care, public health, primary care, hospital care and long-term care through the different phases of the pandemic. There is a need in each phase to compare context-specific bundles of measures where the impact on health outcomes can be modelled using targeted data and advanced statistical methods. Performance intelligence can be pursued to compare data, construct indicators and identify optimal strategies. Embracing a system perspective will allow countries to take coordinated strategic decisions while mitigating the risk of system collapse.A framework for the development and implementation of performance intelligence has been outlined by the HealthPros Network and is of pertinence. Health systems need better and more timely data to govern through a pandemic-induced transition period where tensions between care needs, demand and capacity are exceptionally high worldwide. Health systems are challenged to ensure essential levels of healthcare towards all patients, including those who need routine assistance. CONCLUSION: Performance intelligence plays an essential role as part of a broader public health strategy in guiding the decisions of health system actors on the implementation of contextualised measures to tackle COVID-19 or any future epidemic as well as their effect on the health system at large. This should be based on commonly agreed-upon standardised data and fit-for-purpose indicators, making optimal use of existing health information infrastructures. The HealthPros Network can make a meaningful contribution.